Project

Menarche and menopause in LMICs

Goal: Age at menarche has been declining; better nutrition and increased wealth have been linked to this decline in HICs. Our understanding of the relationship in LMICs is very poor. Scanty evidence suggests that earlier menarche could be characteristic of girls who live in urban, higher socioeconomic status households, as indicated by higher maternal education, better housing quality, and household asset ownership. In addition, age at menarche is significantly associated with birth characteristics with low birth weight having an earlier age at menarche. Similarly, scant evidence shows age at menopause might be occurring earlier in low income settings but so far, the data relate to small studies and are not generalisable. This could have implications for women’s wellbeing. The current limited evidence base precludes generalisability. In these research projects I worked with Dr Tiziana Leone (LSE) to highlight the major gaps in knowledge linking literature from social epidemiology, demography, population health, life course studies, reproductive and mental health as well as bio-demography. These projects used literature and Demographic and Health Surveys (DHS) that have asked the question on age at first period and menopause to review the evidence on the determinants of timing of age at menarche and menopause in LMICs.

Date: 1 July 2018

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Project log

Laura J Brown
added a research item
Introduction Understanding the timing and determinants of age at menarche is key to determining potential linkages between onset of puberty and health outcomes from a life-course perspective. Yet, we have little information in low-income and middle-income countries (LMICs) mainly due to lack of data. The aim of this study was to analyse trends in the timing and the determinants of menarche in LMICs. Methods Using 16 World Fertility Survey and 28 Demographic and Health Surveys (DHS) from 27 countries, we analysed cohort trends and used fixed-effects models for DHS surveys to investigate sociodemographic and regional effects in the timing of age at menarche. Results Trends of the mean age at menarche across time within and between countries show a declining or stalling path. Results of the determinant modelling show the relationship with wealth changes over time although not consistently across countries. We see a shift from poorer women having earlier menarche in earlier surveys to richer women having earlier menarche in later surveys in Indonesia, the Philippines and Yemen, while in Egypt, the reverse pattern is evident. Conclusions There is a considerable gap in both literature and data on menarche. We see a trend which is declining rapidly (from 14.66 to 12.86 years for the 1932 and 2002 cohorts, respectively), possibly at a faster pace than high-income countries and with a strong link to socioeconomic status. This study calls for menarche questions to be included in more nationally representative surveys and greater use of existing data because of its impact on life-course health in fast-ageing settings. Further studies will need to investigate further the use of the age at menarche as an indicator of global health.
Laura J Brown
added an update
Mine and Tiziana's menarche paper exploring trends and determinants in LMICs has now been published
 
Laura J Brown
added a project goal
Age at menarche has been declining; better nutrition and increased wealth have been linked to this decline in HICs. Our understanding of the relationship in LMICs is very poor. Scanty evidence suggests that earlier menarche could be characteristic of girls who live in urban, higher socioeconomic status households, as indicated by higher maternal education, better housing quality, and household asset ownership. In addition, age at menarche is significantly associated with birth characteristics with low birth weight having an earlier age at menarche. Similarly, scant evidence shows age at menopause might be occurring earlier in low income settings but so far, the data relate to small studies and are not generalisable. This could have implications for women’s wellbeing. The current limited evidence base precludes generalisability. In these research projects I worked with Dr Tiziana Leone (LSE) to highlight the major gaps in knowledge linking literature from social epidemiology, demography, population health, life course studies, reproductive and mental health as well as bio-demography. These projects used literature and Demographic and Health Surveys (DHS) that have asked the question on age at first period and menopause to review the evidence on the determinants of timing of age at menarche and menopause in LMICs.